Experience of health professionals in care of the homeless population with tuberculosis

Abstract

OBJECTIVE Analyzing statements of health professionals from a Street Clinic regarding care of a homeless population with tuberculosis. METHOD This is a qualitative research, conducted in the central region of São Paulo at three basic health units in the period of November to December 2014. A semi-structured interview guideline was implemented for data collection and all interviews were recorded using a digital recorder. RESULTS Six health professionals were interviewed. According to the Discourse Analysis perspective, three discursive segments emerged: experiences on care in the streets; weaknesses inherent to the treatment process; and incentives as a means of maintaining sick people in treatment. CONCLUSION Caring for a the homeless population with tuberculosis constitutes a new and challenging experience. It involves difficulties in dealing with the reality of a miserable social context, a lack and inadequacy of services, as well as care limitations for treatment and treatment dropout, which reinforces multiresistance. However, the investigated Street Clinic teams seek to expand access to health and social care services to this population.

A tuberculose na população em situação de rua: desempenho de profissionais da atenção primária

“…Although recommended by the Ministry of Health, intersectoral actions occur in an incipient way mainly due to the lack of communication between the sectors. This lack of communication is pointed out as a problem that weakens the comprehensiveness of the actions, thus hindering the control of tuberculosis in the homeless population (17) .…”

“…As non-adherence to treatment is considered a serious problem in the case of the homeless population, the participation of governmental and non-governmental institutions is essential to minimize the negative impact of this problem (3,(5)(6)16) . It is known that directly observed treatment is the most effective modality for success in the control of tuberculosis; however, the treatment of the disease in this way in homeless people is difficult due to lack of institutional and social resources and professional training (9,17) . The results obtained in this study regarding the actions for the control of tuberculosis may be related to the low performance in the variables of the factor 2, composed by the process of professional qualification, access to manuals, and the practice of the street clinic team.…”

“…The Statistical Package for the Social Sciences, version 17, was used to analyze the data. Initially, an exploratory factor analysis was performed, which has three main goals: to understand the structure of a set of variables, to construct a questionnaire for measure an underlying variable, and reduce a set of data to a more manageable size.…”

O Consultório na Rua e a atenção básica à população em situação de rua

“…Frente a esses desafios, alguns países têm adotado as estratégias de busca ativa e itinerância para superar limitações do modelo de demanda espontânea a esse grupo (Lemke, et al, 2010). Tais estratégias caracterizam-se pelo deslocamento das equipes no território de modo a alcançar pessoas refratárias ou inadaptadas às redes de saúde (Lemke, et al, 2011), superando barreiras ao acesso nos serviços convencionais Varanda, et al, 2004;Mattos, 2006 (Brasil, 2017) e apesar de sua expansão numérica e complexidade das ações, a quantidade de estudos sobre o tema é ainda restrita (Almeida, 2014;Pacheco, 2014;Londero, et al, 2014;Pereira-da-Silva, 2016;Hallais, et al, 2015;Alecrim, et al, 2016;Medeiros, 2016;Davel, et al, 2016;Engstrom, et al, 2016;Ferreira, et al, 2016 contribuições e limitações das iniciativas à equidade em saúde de sua população-alvo, ou seja, analisar o investimento e a organização dos sistemas e serviços no tratamento diferenciado e justo a uma população que vivencia desigualdades (Vieira da Silva, 2009), como as PSRs. Diante da ausência de estudos comparados sobre esse objeto, situaremos a proposta brasileira numa perspectiva internacional comparada, de modo a que a experiência de outros países represente um espelho analítico (Fleury, 2006) e ofereça elementos úteis para a transferência de conhecimentos nesse campo (James, et al, 2003) e subsídios para futuros estudos.…”

“…A primeira delas efetivou avaliação pelo olhar dos usuários do serviço e a segunda tratou do processo de implementação do CnR em nível federal. Outros estudos voltados ao mesmo programa abordaram a análise de saberes ideológicos e instrumentais de uma dada equipe (Kami, et al, 2016), as práticas executadas pelas eCRs no cuidado em saúde (Almeida, 2014;Londero, et al, 2014;Alecrim, et al, 2016;Engstrom, et al, 2016;Machado, et al, 2017), e em suas relações com a educação permanente (Gil, 2016). Também foram abordados, pela perspectiva socioantropológica, o acolhimento e a produção de cuidados oferecidos por uma eCR (Hallais, et al, 2015), e a avaliação sobre as atitudes dos trabalhadores em relação ao uso abusivo de drogas (Davel, et al, 2016).…”